(B) Observational studies of bone mineral density and fractures—children
Study	Ascertainment of BMD	Ascertainment of exposure	Definition of ICS use	Adjustments	ICS exposure	BMD (g/cm)
Agertoft and Pedersen21	DEXA scan at one visit, performed by same investigator blinded to treatment group	Compliance checked: Good Duration: Mean 1603 days	Asthmatic children with ICS use continuously for ≥3 years Type of inhaler: MDI; Turbuhaler Type of steroid: BUD	Log of accumulated dose of BUD; gender; age	Mean ICS BUD dose 504 μg (daily)	Mean BMD: BUD group: 0.92 Control group: 0.92
Allen et al22	DEXA scan at baseline and again at 9–20 months later. Value for 12-month time point calculated with all outcomes	Compliance checked: Adequate Duration of follow-up: 9–20 months	Type of inhaler: Spacer, Turbohaler Type of steroid: BDP, BUD	Age; height; weight; dose of inhaled corticosteroid	Mean ICS dose 0.67±0.48 mg/m2/day	Change in mean vertebral BMD (SD) over 12 months: ICS group (n=47): 0.03±0.03 Control group (n=9): 0.06±0.04 p:<0.025
Bahceciler et al23	Anteroposterior (AP) spine (L2–4) by DEXA scan	Compliance: not reported Follow-up: 13.0±9.8 months	Use of BUD as MDI ≥6 months	None	ICS Mean daily dose (SD): 419±154 μg	Mean lumbar spine BMD: ICS group: 0.593 (SD 0.122)
					Control	Mean lumbar spine BMD: 0.579 (SD 0.156)
Harris et al25	Lumbar spine by DEXA	Compliance checked: not reported Duration of follow-up: 3.5±2.4 years	Stratified by treatment in past 6 months Type of inhaler: Spacer device Type of steroid: BDP,BUD, FP	Weight	0 μg/day	Mean lumbar spine BMD (SD) 0.68 (0.07)
					400–800 μg/day	Mean lumbar spine BMD (SD) 0.70 (0.08)
					>800 μg/day	Mean lumbar spine BMD (SD) 0.67 (0.08)